Turf battles erupt amid Obamacare rollout

SACRAMENTO – In the three years since it was signed into law, President Barack Obama's signature health care overhaul has been alternately lauded as an advance in health equity and condemned as an assault on individual liberty.

But for companies with the right political connections, or health care professionals seeking to expand their services, the Affordable Care Act – or Obamacare, as it's better known – could be described as something far less emotional: a business opportunity.

Over the past year, as the Obamacare debate has shifted from constitutionality to implementation, Capitol insiders, physicians' advocates and political observers say Sacramento has seen some health professions and health care companies use the law to try to further their business interests.

Several health practitioners are using the ACA as a new argument in their perennial quest for more power in California. And the nation's largest vision-benefits company employed threats and political allies to try to force its way onto California's Obamacare-established health exchange.

NEW ARGUMENTS

Pending legislation favoring optometrists, pharmacists and nurse practitioners is a stark example of the new opportunities created by Obamacare.

For years, these and other health practitioners have fought in the Legislature to expand their professions' “scope of practice.” About 30 years ago, podiatrists mounted a furious campaign against orthopedic surgeons to claim the right to perform ankle surgeries. Other battles have pitted optometrists against ophthalmologists over glaucoma treatments and dental surgeons against plastic surgeons over facial cosmetic procedures, among many, many others.

These turf battles are always intense and they end with lawmakers, not medical experts, deciding who can perform which procedures and reap the profits. Generally, the debates revolve around training and patient safety. But Obamacare has provided expansion-minded professions with a new and powerful argument in their favor.

The law's individual mandate, which requires Americans to purchase health insurance, means that about 4.7 million Californians who are not insured today will be required to buy coverage next year.

California, however, doesn't have enough physiciansas it is, and some say Obamacare is just going to make the shortage more pronounced. Optometrists, pharmacists and nurse practitioners are arguing that their authority should be expanded so they can fill in the gaps and provide more care.

This year, Sen. Ed Hernandez, D-West Covina, who is a working optometrist, introduced three bills to expand the services offered by these professions:

•As amended, Senate Bill 491 would allow nurse practitioners to practice independently without the oversight of a physician after an initial period of supervision.

•SB492 would permit optometrists to treat diabetes as well as perform surgical procedures, including using lasers to treat glaucoma, removing eye-lid lesions with scalpels and administer injectable drugs.

Hernandez says the bills are necessary to meet California's medical needs and insists that patient safety would not be compromised if the bills are enacted.

“I'm trying to increase access to primary care with the workforce we already have now,” the senator said.

But to medical doctors, who stand to gain competition under these bills, the proposals don't motivate health care professionals to practice in California's underserved rural and inner-city areas. Jodi Hicks, a lobbyist for the California Academy of Family Physicians, said California's problem isn't so much a shortage of doctors, but the distribution of them. She said Hernandez's bill does nothing to address this fundamental issue.

“The danger,” she said, “is the people are using the ACA as an opportunity to gain in their own field rather than fix the problem.”

The three bills all passed out of the Senate into the Assembly in July, but have since been revised significantly. Hernandez recently announced that he is shelving the optometrist bill until next year, while the other two recently passed out of the Assembly Committee on Business, Professions and Consumer Protection and await further action in the lower house.

POLITICAL MUSCLE

Under Obamacare, states have the option of building their own health insurance exchanges, which are online marketplaces where Americans can directly buy health insurance from private providers.

Inclusion in a state exchange, particularly one as large as California's, is a big business opportunity for insurance companies. More than 5 million Californians will be eligible to buy insurance on the California Health Benefit Exchange, also known as Covered California, when it goes live on Oct. 1.

So it's no wonder that the eye-care insurer VSP, or Vision Service Plan, was upset when the members of the health exchange board voted last August not to offer stand-alone vision plans to individual purchasers who visit its website.

The Sacramento-area company threatened to move out of state and delayed hiring 150 workers. Meanwhile, groups including the California Optometric Association and the Sacramento Metropolitan Chamber of Commerce rallied to VSP's aid, submitting letters on the company's behalf.

Indeed, VSP has a new problem: The federal government is blocking its inclusion on the exchange. In March, the feds released new guidelines that said state exchanges could not offer adult individual stand-alone plans on their websites.

Covered California is “working with vision health insurers and other stakeholders to develop a mechanism to provide access to vision insurance plans,” said exchange spokesman Larry Hicks in an email.

User Agreement

Keep it civil and stay on topic. No profanity, vulgarity, racial
slurs or personal attacks. People who harass others or joke about
tragedies will be blocked. By posting your comment, you agree to
allow Orange County Register Communications, Inc. the right to
republish your name and comment in additional Register publications
without any notification or payment.